Midwives urged by health service to let volunteers help with chores

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Hospitals should use volunteers to relieve the pressure on busy maternity units so that overworked midwives can spend more time with women in labour, a new report urges the NHS.

Many more women could be cared for by midwives if they were freed from tasks such as filling in forms, taking blood pressure and giving breastfeeding advice ...

It is calling on hospitals to use their existing maternity staff in different ways rather than relying on the government to hire more midwives. Midwives' leaders have accused ministers of reneging on promises to hire thousands more to cope with the rising birthrate.

The King's Fund wants the NHS to improve maternity care by ... midwives undertaking some jobs currently done by doctors, such as examining newborn babies; nurses attending elective caesarean section operations instead of midwives; midwives supervising the labour and birth of many women now looked after by a doctor; and maternity support workers taking on extra roles.

The report wants hospitals to copy the experience of a few maternity units that are already working in different ways. For example ... "active labour volunteers", each working up to 18 hours a week. "They provide support in labour by massaging women, encouraging and supporting them, and staying with them if a midwife has to leave the room to do other things," ...

... "task-shifting" has increased the amount of time midwives spend with mothers-to-be from 32% to 50%. A round-the-clock ward clerk has been hired to welcome expectant mothers and help them fill in their paperwork, allowing the midwives to concentrate on one-to-one care of women in labour. Hospital managers had found that midwives were spending 32% of their time dealing with patients but 34% on clerical duties.

A dedicated equipment store means midwives no longer have to search wards for machines such as heart-rate monitors, while an electronic keypad security system for the nine drugs cupboards has ended midwives' regular searches for the two sets of keys previously needed to unlock medication for epidurals ...

At Bedford hospital, nurses help look after women having caesarean sections so midwives can spend more time on antenatal screening, surveillance and one-to-one labour care.

Anna Dixon, the King's Fund's head of policy, said such innovative practices could greatly increase the number of low and medium-risk pregnant women whose care in labour is supervised by a midwife ...

But Cathy Warwick, general secretary of the Royal College of Midwives, said that while midwives could take on some new roles "these should not be added at the expense of the essential care many midwives are currently struggling to provide because there simply are not enough of them to deal with their current workload". She also voiced concern at other health workers taking on roles in maternity care. "You cannot compensate for not having the right number of midwives by transferring to other members of staff care that only midwives can and should provide," Warwick said.

... The Royal College of Obstetricians and Gynaecologists said: "The new report misses the crucial fact that midwifery care is needed throughout a woman's pregnancy. For continuity of care to occur, more midwives are needed."